Investigational drugs against COVID-19
Probable or confirmed,the Covid-19 pneumonia in adults is treated with the following drugs: chloroquine (CQ), hydroxychloroquine (HCQ), tocilizumab, lopinavir or ritonavir, and remdesivir.
The following factors help doctors in determining the treatment of patients who have probable or confirmed pneumonia:Rate of breathing (respiratory rate) and oxygen level in the blood (pO2) and presence or absence of respiratory distress; age – whether patient is 60 years old and above or younger; presence or absence of co-morbid conditions such as hypertension, coronary artery disease, diabetes, structural lung disease – chronic obstructive lung disease; bronchiectasis; diabetes mellitus; immunocompromised state – HIV, prolonged use of steroids and other drugs that suppress the immune system; and advanced cancer
It is then determined if conservative management is done at home, or the patient is admitted. Use of these drugs is based on Chinese and European anecdotal experiences. These drugs are called investigational drugs.
Chloroquine phosphate is an aminoquinoline used as prophylaxis for malaria and to treat diagnosed cases of malaria. It may also be used to treat extraintestinal amoebiasis and off-label as a treatment for lupus. It is currently under investigation for use in the treatment of the Covid-19. Its safety and efficacy have not been established yet. Adverse reactions involve most organs of the body – the heart, central nervous system, skin, the bone marrow, liver, the eyes, and the ears. Hypersensitivity contraindicates its use. Chloroquine use reportedly lead to reduced progression of the Covid-19 disease and decreased duration of symptoms
Hydroxychloroquine is also an aminoquinoline used to treat malaria, lupus erythematosus, rheumatoid arthritis treatment. It has stronger antiviral activity.
For the Covid-19, its use is based on one small study in hospitalized patients. Adverse reactions also involve most organs of the body like the heart, eyes and ears, skin, gastrointestinal tract, bone marrow, liver, nervous system, and muscles. It is not given to patients allergic to it.
Tocilizumab is a disease-modifying anti-rheumatic drug, classified as interleukin-6 receptor antagonist. It is used in the treatment of the Covid-19 associated lung complications with elevated IL-6 levels.
Lopinavir or ritonavir is an antiretroviral drug classified as a protease inhibitor. It is used in combination with other drugs in treating HIV. Adverse reactions involve most organs of the body.
Remdesivir is a nucleotide analogue drug that inhibits RNA synthesis. It is not commercially available and is being used as part of ongoing clinical trials on treatment of the Covid-19. It has activity against severe acute respiratory syndrome. There are no specific drug to drug interaction data available yet. Clinical trials were on patients 18 years old and above. Compassionate use is being considered for pediatric patients with severe disease.
Using Chloroquine CQ or HCQ for prevention of the Covid-19 is not recommended. Informed consent is needed before any of the investigational drugs are used. The side effects and complications arising from drug interactions are explained to the patient and relatives.
On other drugs,the World Health Organization and the Centers for Disease Control do not recommend the use of glucocorticoids in patients with the Covid-19 pneumonia unless there are other reasons for its use.
The European Medicines Agency and WHO do not recommend avoidance of nonsteroidal anti-inflammatory drugs,when their use is clinically indicated.